Bundled payment program has launched with care providers in New Jersey and Texas, with plans to expand to as many as 20 care provider groups by year-end 2019
Developed in collaboration with the U.S. Women’s Health Alliance, the program will be expanded to additional care provider groups that deliver quality, efficient care
Payment model builds upon existing maternity care program that has helped reduce the cesarean delivery rate for low-risk pregnancies across UnitedHealthcare’s employer-sponsored health plans to below national targets1
UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, has introduced a new bundled payment program for maternity care to help support the well-being of moms and babies before and after delivery by closing gaps in care and encouraging healthy, full-term pregnancies.
The new bundled payment program for maternity care has launched with two health care providers, Lifeline Medical Associates in New Jersey and Privia Medical Group – Gulf Coast in Texas, to help encourage more coordinated care and better health outcomes for expectant mothers enrolled in UnitedHealthcare employer-sponsored health plans. By year-end 2019, UnitedHealthcare will expand the bundled payment program to as many as 20 care provider groups, including ones affiliated with the U.S. Women’s Health Alliance, a national organization of leading health care practices.
The payment model builds on the UnitedHealthcare Maternity program*, which has helped women by contributing to fewer non-medically indicated cesarean (C-section) deliveries, reduced both pre-delivery hospital admissions and the average length of stay in the neonatal intensive care unit (NICU), and decreased other delivery and newborn-related costs.2 The C-section rate for low-risk pregnancies among women enrolled in UnitedHealthcare’s employer-sponsored health plans in 2018 was 18 percent,1 lower than the 23.9 percent target set by the federal government.3
Approximately one-third of babies nationwide are born via C-section, according to the Centers for Disease Control and Prevention (CDC). Studies have shown that early, non-medically indicated C-sections are linked to a higher risk of complications, including infection, hemorrhage or blood clots, and admission to the NICU.4
For a first-hand account of how UnitedHealthcare’s maternity resources helped support a healthy, full-term delivery for a new mom, click here.
“These resources can help improve access to quality, coordinated care, offering important support to women and families before, during and after delivery,” said Janice Huckaby, M.D., who leads UnitedHealthcare’s women’s health initiatives as a senior vice present and regional chief medical officer. “Value-based care programs such as this help improve clinical quality, patient safety and satisfaction, and care coordination among physicians, with the goal of reducing costs.”
The bundled payment method reimburses a care provider or hospital for a defined episode of care (EOC), such as prenatal, delivery and postpartum services, under a single fee or payment. This is a shift away from the common fee-for-service structure in which a care provider is paid for each treatment, appointment or test, generating multiple claims within a single, broader episode of care. Bundled payment methods reward care providers for value over volume, helping align incentives and linking reimbursement to the delivery of coordinated, efficient care.
“The collaboration to develop and launch this maternity episode of care program marks an important next step in our journey to improve the quality and affordability of care for women across America,” said Jack Feltz, M.D, president of the U.S. Women’s Health Alliance. “This transformative program helps give care providers the necessary resources to make a difference in improving quality while decreasing costs.”
The UnitedHealthcare Healthy Pregnancy® mobile app** and Maternity program provide expectant women with personalized content and 24/7 nurse support. Nurses can coordinate care, help with the management of chronic conditions, and connect pregnant women with behavioral health care teams for emotional and mental health support. These resources are provided in collaboration with Optum, UnitedHealth Group’s health services business.
Eligible people can download the app onto their iPhone® and Android® devices, enabling expectant parents to:
Employers can offer these resources to their employees at no additional cost as part of their benefit plan.**
The maternity care bundled payment program is part of UnitedHealthcare’s ongoing commitment to value-based care. By the end of 2020, the company expects to have $75 billion in care provider reimbursements tied to value-based arrangements annually, which support the health of UnitedHealthcare plan participants at no additional charge.
“Bringing together industry stakeholders with the collective vision to work together to improve care quality and affordability will be crucial for modernizing the nation’s health care system,” said Mark Cone, M.D., FACOG, market president, Privia Medical Group – Gulf Coast. “On behalf of our doctors at Privia Medical Group, we are excited to be a part of this collaborative effort.”
UnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. In the United States, UnitedHealthcare offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1.2 million physicians and care professionals, and 6,500 hospitals and other care facilities nationwide. The company also provides health benefits and delivers care to people through owned and operated health care facilities in South America. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visit UnitedHealthcare at www.uhc.com or follow @UHC on Twitter.
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*The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical and/or nutritional advice. Participants should consult an appropriate health care professional to determine what may be right for them. Employers are responsible for ensuring that any wellness programs they offer to their employees comply with applicable state and/or federal law, including, but not limited to, GINA, ADA and HIPAA wellness regulations, which in many circumstances contain maximum incentive threshold limits for all wellness programs combined that are generally limited to 30 percent of the cost of self-only coverage of the lowest-cost plan and prohibitions on incentives to dependent children, as well as obligations for employers to provide certain notices to their employees. Employers should discuss these issues with their own legal counsel.
**The UnitedHealthcare Healthy Pregnancy application is available only to eligible participants enrolled in certain employer-sponsored plans. Application registration is required.
1 UnitedHealthcare Economics Women’s Health Outcomes Analysis, 2018
2 Optum Healthcare Economics Maternity Program Analytics Study, 2018
3 Office of Disease Prevention and Health Promotion
4 The Journal of Maternal-Fetal & Neonatal Medicine, 2016